HomeMy WebLinkAboutBogovic # 14\ ir ;
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .Q Southold, New York 11971
MARRIAGE OFFICER J,' Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1918-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BOGOVIC, PETER
Mailing Address 1 1980 NORTH BAYVIEW ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1120 LOWER ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1613
Tax Map No. section 69.00 block 6 lot 2.000
Cross Street AKERLY POND ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/12/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
N
OFFICE OF THE TOWN CLERK ,S\FFO(,��'= J
Town of Southold �� l- Application No. / ,'/r
Judith T. Terry, Town Clerk .%�
Town Hall, 53095 Main Road , x d ti $10.00 - Residential
,P. O. Box 1179 Ui �I < i $25.00 - Non-Residential
Soutold, New York 11971 O "�^ .. �•I'•
Telephone 1�A
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Perm't No.
Fee $ ® o !
�U DATE 1/L ) 07012
OWNER NAME: pe... iet 5 42,30 //`G
OWNER MAILING ADDRESS: 17$ 0 Af, ,8e9/1// e GL ACS, Se�oZ
OWNER PROPERTY ADDRESS: itt2-10- 0u/e.7- / aS'otif old/ /111i/q7 /
OWNER TELEPHONE NUMBER: 76 ,j !/6 /3
TAX MAP NO. : Section 6 9 Block l‘a Lot
CROSS STREET: ,C�'`- --
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
:re?--',.' #ertk.9
Signature of Ap i f cant
RECEIVED BY:. / (--A-1 "---
i
•wn Clerk's Office
•
DATE: /
f U, C.
P
' —NV'
r 2:C)
id,' .•.'-' 0/-- / .'\ .st•t•4: _
SO
13
, ..._
,......
L-
rO1Yt=' J7;7tlr+f� •1 :� '.^ T
1 ; �-1 ^
•
U.\ C3
` \ ,/
bl
Z; ,
. Cj / .i / • s / Yom^ ri C�;7;ir
`�� c\ W•
pre v1 � ' C.
Cr)
1 `1- , I !
J
.,./ . .
/ I
` LC--a
rrJ UNAifii{pFZrD ALT. . ."N C
+ EA
J i0 TrifS SL`:VtY t$ .^• J:.aTJn:<!`1E .�^ck,•f!�l j1t;.C.' L.i'{i'1✓Y•f i_c./ 'f=- .`���f r(1r�4:t (:��j
z __1 F / • SECTION 1209 II, N v:1:- I•• r _ r
LL EDUCATION L. r!. i'Y•• - / �s f�
---- •
---------".- �. Ai —.o •�'0.,,:).' %'�, ./b . h COPIES G''T-JS SU:SL•' ��
ic. THE MAP OT I.E: ;l�G,�
LA • SU4VE,J^,', r'QJ:..D SE 3: VP J 1
EMS•:SED SEAL 5;.=1:.L N:.'1 EC CONL"11.'%Ip 1...J ru([-'.' . ' C� l�f :'1 7Z(41/r I` .
/ T E A VALID 11tUL C.C,Pr. __
,~J IC..a�.._ /`��! V G��YJ)��I CNLY TOrTF'EIF nJSp�EO (;L'S:^,N SI<ALL' UIJ __ / 2' 1 ''r -' .— _ _,%,./
/ IS FGCPARED, • '.]? 'r+;,t;,; r.. .Nr:Y _/ ✓ �. 'w..t Y...
TITLE COAiPANf, C',yE,::::F.t..rii,.AC.LJ' !hf\D L._/C '.''"I`� t.+' t___ �' r. +Lf 0 r
TO THE ASSIGNEES Oh t .)-,...(,)
r !-
TIC LE;t6iNG L 13 b r y r
-_ TUTION. (:UAFAtcricLS A4-l',Of' C C f t!��Li r I - .r�!fE_'L-r'y� x f-�
TO ADDITIONAL i,'�SLJGfrt„a,"ORtSUESI 1.4NT
OWNE _
PS.
f „ '